VA Mental Health Provider Venting / Problem-solving / Peer Support Thread

[Grenth]

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Just when I think things can't get stupider here.

My direct contact hours expectation is 25 hours a week. I get about 4 hours carved out for various things dropping me to 21. They decided to redo my clinic grids using some kind of arcane logic that no one can explain to me properly but goes something like this

Head MSA with the full endorsement of my boss : Dr. Grenth, some nameless ghouls we refuse to identify have ordered us to get rid of your intake and new patient clinics. You now have one giant clinic.

Me: Then how will you prevent me having 21 intakes a week with no follow-ups?

Them: well, if a 90 minute block is scheduled with nothing before and nothing after it went assume it's an intake. If it's a 60 minute appointment with nothing before and nothing after then it's a new patient. Returning patients can be back to back

Me: that's all fine and good but that destroys my existing schedule and doesn't work mathematically with my existing meetings and carve outs.

Them: we fixed it for you, here's a grid with 18.5 hours instead of 21.

Me: so I will see 2.5 fewer patients a week now?

Them: Yes you're welcome that we fixed this for you.


So stupid it's unreal. And they want me to overbook to make up the hours they can't grid but our MSAs won't fill requested overbook without you holding their hands and bribing them.

There goes my top RVU status that no one ever cared about 🥲

 

[Sanman]

My referrals have come to a grinding halt recently and I imagine will not be back on track until after the 4/14 RTO because providers are stressed and focused on other things.

In addition, apparently no one can actually agree who is looking for office space for remote providers outside of the local radius.

I feel bathed in glory of efficiency and competence. America is truly ______ again!

At least I'm not the guy they accidentally sent to an El Salvadorian prison.

 

[DoubtfulDoc]

You mean the ones equipped with laser weapons?

They kind of look like that!

 

[psy.d. 2021]

Anyone else get cameras placed in their clinic hallways within the last several weeks?

I'll look next time I'm in. I'm surprised they haven't added badge scanners. They need to take bids for that and begin the 12 month process

 

[WisNeuro]

When are they going to add mandatory self flagellation and ablutions in front of an alter to Cheetoh Jesus before you can start your tour of duty?

 

[VintageRed]

Does anyone have any sense of how “bumping and retreating” would look for psychologists? It seems like it would be a giant mess and I can’t seem to grasp how this would look in reality.

 

[Psychologist1234]

When are they going to add mandatory self flagellation and ablutions in front of an alter to Cheetoh Jesus before you can start your tour of duty?

…you’re not already preemptively doing that?

**writes down your name**

 

[WisNeuro]

…you’re not already preemptively doing that?

**writes down your name**

Oh, I escaped the clutches of the VA long ago, no longer an employee of the Executive Branch. But, also apparently not safe from being sent to an El Salvadoran prison either, as I do have a tattoo...

 

[aim-agm]

Apparently this neuropsychol(ogy) consult title is for all psych assessment and there's nothing we can do about it, since it's nationally mandated for standardization... so I guess I'm a neuropsychologist now!

Again, my anger about this is probably not fitting the facts in terms of intensity but ARGH people already think all psych testing is neuropsych and this is NOT gonna help matters.

That's odd, our consult names were updated as part of the same national standardization and we do have the same NEUROPSYCHOL (sic) consult title, but we also have a separate general psych assessment consult title

 

[summerbabe]

Does anyone have any sense of how “bumping and retreating” would look for psychologists? It seems like it would be a giant mess and I can’t seem to grasp how this would look in reality.

Supposedly title 38 and hybrid t38 positions like psychologists are not eligible for bump and retreat in a RIF (since there isn’t anywhere for us to go down the GS ladder like in my non-clinical areas).

But I wonder if a GS14 supervisory position got eliminated, could that person be reassigned to a standard GS13 spot and then a GS13 in that organization (via seniority and/or performance) would get RIFed?

 

[Sanman]

Supposedly title 38 and hybrid t38 positions like psychologists are not eligible for bump and retreat in a RIF (since there isn’t anywhere for us to go down the GS ladder like in my non-clinical areas).

But I wonder if a GS14 supervisory position got eliminated, could that person be reassigned to a standard GS13 spot and then a GS13 in that organization (via seniority and/or performance) would get RIFed?

I see someone has been attending the HR RIF meetings and paying attention... now back to pretending that nothing is going on here.

 

[ccpsych16]

Just when I think things can't get stupider here.

My direct contact hours expectation is 25 hours a week. I get about 4 hours carved out for various things dropping me to 21. They decided to redo my clinic grids using some kind of arcane logic that no one can explain to me properly but goes something like this

Head MSA with the full endorsement of my boss : Dr. Grenth, some nameless ghouls we refuse to identify have ordered us to get rid of your intake and new patient clinics. You now have one giant clinic.

Me: Then how will you prevent me having 21 intakes a week with no follow-ups?

Them: well, if a 90 minute block is scheduled with nothing before and nothing after it went assume it's an intake. If it's a 60 minute appointment with nothing before and nothing after then it's a new patient. Returning patients can be back to back

Me: that's all fine and good but that destroys my existing schedule and doesn't work mathematically with my existing meetings and carve outs.

Them: we fixed it for you, here's a grid with 18.5 hours instead of 21.

Me: so I will see 2.5 fewer patients a week now?

Them: Yes you're welcome that we fixed this for you.


So stupid it's unreal. And they want me to overbook to make up the hours they can't grid but our MSAs won't fill requested overbook without you holding their hands and bribing them.

There goes my top RVU status that no one ever cared about 🥲

Dealing with this issue now and there are only 2 of us psychotherapy providers left. We are extremely micromanaged and I am asked why I have 2 open slots in a month time span. TWO.

I thought I escaped this trapped in a hell hole feeling once I left grad school. But living in a resource desert means this is the only available psychologist job outside of setting up your own PP, which obviously takes time and money. Our colleagues who could retire did or will. The rest of us ECPs are stuck for the time being. I’ve never been so miserable, daily, because of work (or school—grad school was awful) for such an extended period of time. Just venting.

 

[WisNeuro]

Dealing with this issue now and there are only 2 of us psychotherapy providers left. We are extremely micromanaged and I am asked why I have 2 open slots in a month time span. TWO.

I thought I escaped this trapped in a hell hole feeling once I left grad school. But living in a resource desert means this is the only available psychologist job outside of setting up your own PP, which obviously takes time and money. Our colleagues who could retire did or will. The rest of us ECPs are stuck for the time being. I’ve never been so miserable, daily, because of work (or school—grad school was awful) for such an extended period of time. Just venting.

Less than most people think, especially for those who are doing primarily therapy. I could get someone up and going with an LLC, an office, and some patients within a month for therapy for like a grand, maybe a little more if they don't have a Regus nearby.

 

[Fan_of_Meehl]

Dealing with this issue now and there are only 2 of us psychotherapy providers left. We are extremely micromanaged and I am asked why I have 2 open slots in a month time span. TWO.

I thought I escaped this trapped in a hell hole feeling once I left grad school. But living in a resource desert means this is the only available psychologist job outside of setting up your own PP, which obviously takes time and money. Our colleagues who could retire did or will. The rest of us ECPs are stuck for the time being. I’ve never been so miserable, daily, because of work (or school—grad school was awful) for such an extended period of time. Just venting.

"I am asked why I have 2 open slots in a month's time span."

How could this POSSIBLY be on you? You don't even do your own scheduling. We're not ALLOWED to.

 

[cara susanna]

Anyone else get cameras placed in their clinic hallways within the last several weeks?

I'm really curious about what the purpose of this is.

 

[ccpsych16]

"I am asked why I have 2 open slots in a month's time span."

How could this POSSIBLY be on you? You don't even do your own scheduling. We're not ALLOWED to.

Well clearly we are just BSing all day! Lazy federal workers and all that…. And no one seems to understand that having a couple of open slots is good because if someone needs to reschedule, or reaches back out with an urgent need, they can be seen quickly. It’s all about numbers to them.

Less than most people think, especially for those who are doing primarily therapy. I could get someone up and going with an LLC, an office, and some patients within a month for therapy for like a grand, maybe a little more if they don't have a Regus nearby.

Real estate here is a nightmare. There is I think one group practice, and their cut is abysmal. I’ve had colleagues interview recently and decide against it. It would be something like a $50k or greater pay cut. Haven’t heard of success stories in this area for solo practices, people end up moving 3 hours in any direction to the closest metro areas to be successful. Regardless, I am working on getting licensed here to get the ball rolling. I will start out as a telehealth practice and transition to physical (maybe) at some point. We know we won’t live here forever, but at least the next 1-2 years. I’ll entertain physical at that point.

 

[Sanman]

I'm really curious about what the purpose of this is.

To make workers as uncomfortable as possible.

 

[WisNeuro]

To make workers as uncomfortable as possible.

Daily beatings will continue until morale improves.

 

[Sanman]

Well clearly we are just BSing all day! Lazy federal workers and all that…. And no one seems to understand that having a couple of open slots is good because if someone needs to reschedule, or reaches back out with an urgent need, they can be seen quickly. It’s all about numbers to them.


Real estate here is a nightmare. There is I think one group practice, and their cut is abysmal. I’ve had colleagues interview recently and decide against it. It would be something like a $50k or greater pay cut. Haven’t heard of success stories in this area for solo practices, people end up moving 3 hours in any direction to the closest metro areas to be successful. Regardless, I am working on getting licensed here to get the ball rolling. I will start out as a telehealth practice and transition to physical (maybe) at some point. We know we won’t live here forever, but at least the next 1-2 years. I’ll entertain physical at that point.

Definitely start with telehealth and see what happens then. I don't recommend jumping into a bad group practice cut unless it is temporary and part-time while you relocate.

 

[AcronymAllergy]

Definitely start with telehealth and see what happens then. I don't recommend jumping into a bad group practice cut unless it is temporary and part-time while you relocate.

Agreed. And given how bad the split seems to be, I wouldn't at all be surprised if they include a ridiculously restrictive (and potentially illegal) non-compete clause, or the equivalent of one (e.g., badmouthing you to all of their referral sources and current patients).

 

[Sanman]

Is it just me or is the lack of backbone and clear communication at all VA levels really showing up right now. People being called back, no answers, and I am listening to panicked colleagues everywhere.

 

[Fan_of_Meehl]

Is it just me or is the lack of backbone and clear communication at all VA levels really showing up right now. People being called back, no answers, and I am listening to panicked colleagues everywhere.

anti-leadership FTW!!! Woohoo!!!

 

[Therapist4Chnge]

Agreed. And given how bad the split seems to be, I wouldn't at all be surprised if they include a ridiculously restrictive (and potentially illegal) non-compete clause, or the equivalent of one (e.g., badmouthing you to all of their referral sources and current patients).

Agreed.

There are so many predatory practices out there.

 

[Fan_of_Meehl]

Literally sat in mtg earlier today where someone leading the meeting announced flatly and with a straight face..."Leadership's guidance [on what to do about the ban on DEI training/language and the internship program's curricula] is... that "there is no guidance.""

I was the only one who wouldn't/couldn't manage to keep a straight face.

 

[Shiori]

 

[psy.d. 2021]

New VA DRP came out. Psychologists again not eligible to take it. It'll be funny (as in, not funny) when Psychologists end up getting RIF'd after being denied deferred resignation twice

 

[Sydney Huffman]

Latest update from my leadership is that RTO for "telementalhealth" guidance should be coming next week. They specifically said that anyone who has already returned to office will be expected to continue in office until otherwise directed.

 

[aim-agm]

New VA DRP came out. Psychologists again not eligible to take it. It'll be funny (as in, not funny) when Psychologists end up getting RIF'd after being denied deferred resignation twice

I don't know if anyone at the VHA is eligible, even janitors are on the exclusion list.

 

[psy.d. 2021]

I don't know if anyone at the VHA is eligible, even janitors are on the exclusion list.

Yet they'll end up RIF'ing janitors. It's terrible

 

[futureapppsy2]

The exclusion list confuses me because you KNOW that they’ll RIF a good number of people in excluded positions.

 

[summerbabe]

If I had to guess, the goal is to get a bunch of VISN, VACO, HR and Administrative Officer types of accept this offer before a bunch of them get RIFed (along with an undetermined number of exempt staff who can’t take this offer).

Not sure if that’s gonna work because I imagine many of them will receive a greater severance amount under RIF if they have to work through July 1 as part of DRP 2.0.

 

[Psychologist1234]

Latest update from my leadership is that RTO for "telementalhealth" guidance should be coming next week. They specifically said that anyone who has already returned to office will be expected to continue in office until otherwise directed.

Still no clarification on what is included in “telementalhealth?”

 

[Pragma]

Basically 3 months severance with benefits

 

[psy.d. 2021]

The exclusion list confuses me because you KNOW that they’ll RIF a good number of people in excluded positions.

We want to get rid of you....but on OUR time. Not yours

 

[IWillSurvive]

Still no clarification on what is included in “telementalhealth?”

Very interested to hear if anyone else has clarification on this…

 

[ac23]

What is a reasonable/ethical amount of notice to give before leaving VA?

 

[AcronymAllergy]

What is a reasonable/ethical amount of notice to give before leaving VA?

I'd say at least a month, preferably two. Three if you want to be really nice.

 

[Sanman]

I'd say at least a month, preferably two. Three if you want to be really nice.

You are nicer than I. I was going to say 4-6wks, but I believe only two is required.

 

[summerbabe]

What is a reasonable/ethical amount of notice to give before leaving VA?

I think this is role dependent.

I gave about 2.5 weeks when leaving a
VA acute inpatient role for a transfer because the final offer came later than anticipated.

But when I called out or was on advanced leave, nobody arranged coverage except to contact neuropsych as needed for assessments (versus if the psychiatrist, PA or SW was out and they pulled somebody else into the unit) so I wasn’t technically essential.

So PCMHI would be different than BHIP where everybody is scheduled months out.

It’s also possible that your hospital or clinic might have official SoP guidance related to adequate notice.

You can always propose a resignation date that feels adequate based on your role and need to leave. Your supervisor/service can always decline that date and negotiate/inform you of a different timeframe.

 

[AcronymAllergy]

You are nicer than I. I was going to say 4-6wks, but I believe only two is required.

Hah, I think 4 to 6 weeks is fine. Especially in a large system like VA that has (or at least had) infrastructure in place to handle things like contacting patients, rescheduling, etc.

 

[cara susanna]

We once had someone quit and leave the same day. I don't recommend it though, lol

 

[summerbabe]

We once had someone quit and leave the same day. I don't recommend it though, lol

 

[R. Matey]

I would watch an inspirational movie where a bunch of psychologists left to start their own VA

 

[cara susanna]

Guess who had just started in her own position and inherited ALL of this person's patients and groups

 

[Sanman]

Guess who had just started in her own position and inherited ALL of this person's patients and groups

 

[Action_Potential]

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Very interested to hear if anyone else has clarification on this…

Per my network director - based on % of services offering via synchronous telemedicine. All my appts are vvc, so I was on the telemedicine list.

 

[TrueButUseless]

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Per my network director - based on % of services offering via synchronous telemedicine. All my appts are vvc, so I was on the telemedicine list.

VA hotline call sharepoint explains how the decision was made. Search the sharepoint for “hotline” and you’ll find a wealth of info.

 

[cara susanna]

Any other PE therapists feel that, at this point, they could act out the Dateline video?

Also, i want to know if Sherry ever published that book.

 

[Shiori]

Is anyone else in the VA GPT beta? I have been tinkering with it. I don't think it'll revolutionize my work, but it might help me sound more coherent in some of my notes and emails.

 

[cara susanna]

I refuse to use AI for ethical reasons, not that I would judge VA clinicians who choose to.